I've never bought into the idea of 'organic' produce - there are some solid organic principals and guidelines which I think are Good Things, like reducing pesticides and biodiversity, but Organic True Believers™ would have no truck with my post-modern woolly organicity.

I'll also say, I've never trusted the Organic High Priests like the Soil Association, whose take on organic food has been put through the PR mill, so that the perceived benefits are trotted out as fact and exaggerated and whose scientific credentials leave a lot to be desired. You'll remember, no doubt, that The Soil Association awarded Gillian McKeith its Consumer Education Award 2005 - information the Soil Assoc has decided should no longer be on their website.

• There is no evidence to show that crops grown organically have a better nutrient content than those produced non-organically. However, it has been acknowledged that little research has been conducted to date and much of the available scientific information is out-dated or based on inadequate study design.

Historically, the cost of organic food has been considerably higher than ordinary food, but this gap has closed significantly over the last number of years. Food prices in general have risen and with the current economic credit crunch, people are tightening their belts. What will be first against the wall? People's principals. So much so, according to The Times, that organic farmers are lobbying government to allow them to take an Organic Holiday, so that they can buy the much cheaper ordinary feed during these hard times. According the newspaper:

Sales of organic food slumped 10 per cent in the 12 weeks up to the end of November, according to the latest figures from the consumer researchers TNS. Overall food sales over the same period were up 6 per cent

To me, this idea is nonsense. One concept that has been used frequently with organic farming is the idea of sustainability. Usually this has been in the context of biodiversity, protection of hedgerows, maintaining the wildlife equilibrium etc - all good things, but in fact, of questionable importance if the food you are producing is not commercially viable. You end up with less 'conventional' land to provide more food. Sustainability means being able to sustain your business during tough times. How on earth can you forgo your principals? I don't think they'll be given leave to do this - the main problem I see is that it will be a PR disaster.

Firstly, you are offending your True Believers™, the people who have completely bought into the Organic Religion. They will not tolerate a change to the Holy Book, and it could lead to a split. The word 'organic' will lose its meaning and brand identity (Chemists would argue this has already happened once).

Secondly, you've already lost the people fleeing to Lidl who weren't true believers, and now that they've been away, it'll be difficult to get them back. The beliefs of animal welfare and no pesticides were 'nice thoughts' for them, perhaps they bought organic as a social status symbol or because they had a few extra pennies. I would have thought someone buying organic would be subject to some sort of cognitive dissonance if they went back to normal food. How could they justify their previous lavish expense? Can they really taste a difference?

How many of the farmers are True Believers™ and how many converted to organic because at one time it was a lucrative business move? Can these farmers be trusted to maintain the scrupulous organic standards when bills are stacking up and produce is not going out of the gate? This is not to characterise farmers as underhanded, merely to present the situation as being a truly difficult decision.

According to the Organic Farmers and Growers statement on the Times story, no approach has yet been made to DEFRA, although they do state:

It is, however, fair to say that the broad aims would be to allow farmland to remain organic, even if the animals on it were to be fed on non-organic rations for a limited time, thereby enforcing the removal of the animals from the organic system.

So you can have organic farmland, with normal livestock on it eating normal foodstock and when times get better, jump back into the Organic circle. Normal farmers trying to get into organic farming have to maintain their land as organic for three years before they get the cert. If you are in the year 2 of your 3 year run, does it count? IF so, it makes a mockery of the whole 3 year hoop.

Without any sense of irony, the OGF finish their statement with the following:

The industry’s aim is to protect the organic system for the welfare and environmental benefits it brings and ensure that progress made in expanding this sustainable method of farming is not lost.

Tuesday, December 16, 2008

Of course, the media - who according to Dr Ben Goldacre in the above link are largely responsible - have switched allegiances and act as if their constant publishing of nonsense and scare stories relating to MMR never happened.

At least, after ten years, the media will now admit (in accordance with what respectable health practitioners have been saying for a decade) that it was a hoax - the NHS website on MMR states the site is no longer being updated and the Department of Health has announced an MMR vaccine catch-up campaign.

Levels of measles have been rising over the last decade, but perhaps we are at a turning point, as this week, in Scotland the percentage of under fives having received the first dose stands at 95%, for the first time.

Nonetheless, one of the many hangovers to come-out of the MMR booze-up was JABS - Justice Awareness, Basic Support. This is a 'support-group' for vaccine-damaged children, or to put it cynically, people whose children have developed problems, which the parents put down to vaccines, irrespective of the evidence. JABS became synonymous with an anti-MMR stance (indeed anti-vaccine in general), and so no amount of evidence would ever convince them of its relative safety. Many articles and blogs have criticised JABS for its terrible 'science' or its abusive nature towards anyone who dares suggest that MMR and autism are not connected.

With your monitor set to 'Weird Mode' have a look at a JABS conversation here.

Indeed.

The Science Museum is one of London's great free museums, holding over 300,00 artefacts of scientific and medical significance. The website also contains a section called 'Antenna' which is the Science News section, with a special section on MMR:

For three months you've been telling the Science Museum your concerns about MMR - the measles, mumps and rubella triple vaccine.

Armed with your questions, fears and arguments a team from the Museum set off to interrogate the major players in the controversy.

Controversy? Not for a long time. Hoax would be a better choice of word.

Clicking on "What about single jabs?" and then "Where can I get them?", the Science Museum website happily suggests emailing JABS for some advice. The Science museum suggests contacting an anti-vaccine pressure group on advice for vaccines. Perhaps the Science Museum should be weighing up government advice and making a decision on the evidence rather sending parents, who are trying to do the best by their kids, to rather odd inhabitants of JABS-world.

The JABS website itself states:

JABS is not primarily a provider of vaccine information but a support group of parents who feel their children have suffered a reaction or have been severely damaged by a vaccine

... so what is the point of sending people there who are trying to find out about single vaccines? Despite this website claim, the Science Museum has page with a photo of Jackie Fletcher (JABS co-ordinator) stating:

Jackie Fletcher of vaccine-damage support group JABS also offers advice for parents regardless of whether they are opting for single jabs or the full MMR.

How balanced an opinion do you think you will get from JABS on this issue?

It's clear the Science Museum needs to completely update and revamp its MMR site, and do its part to relegate the MMR hoax to science history.

EDITED 17/12/2008: If you would like to let the Science Museum know about their backwards stance on this issue, the contact details are here.Hat-tip to Duck & Tristan @ Bad Science.

Sunday, December 14, 2008

Media reporting of science is a beautiful thing to behold, and usually dreadfully and woefully wrong. Read the original study and you are pretty much guaranteed to find that the study found almost the complete reverse of what was reported.

The 'meditation' bit comes about because the therapy uses some meditation techniques. But do not be fooled - MBCT isn’t meditation, it’s a therapy. We’ll deal with the Daily Mail headline a bit later. Never mind whose meditation techniques it uses, does it actually work? For now let’s look at the results:

The Daily Mail and the BBC don’t quite agree on how effective it is. The Daily mail says

47% of people with long-term depression who underwent the therapy suffered a relapse, compared to 60% of those taking anti-depressant drugs.

And the BBC says

The trial of 123 people found similar relapse rates in those having group therapy and those taking drugs.

So what’s going on? The Daily Mail seems to imply that MBCT is better, while the BBC says they are similar. Is 47% really similar to 60%?

The abstract says

MBCT were 47%, compared with 60% in the m-ADM group (hazard ratio = 0.63; 95% confidence interval: 0.39 to 1.04)

The Daily Mail got the numbers right. What about the stuff in brackets? The hazard ratio is similar to, but not the same as relative risk. In this study the hazard ratio is a measure of the effect of MBCT on relapse rates. The 95% confidence interval is an estimate of the hazard ratio you would get if you repeated the experiment. But there is something missing…

Why haven’t they quoted the statistical significance usually denoted as p? Did they forget? Or not think it was very important?

Statistical significance is used to test the null hypothesis – i.e. the hypothesis that there is no effect. I worked out p using chi-squared test of significance. I got p=0.12. Normally in biomedical sciences p<0.05 is considered to be significant, and so by that standard we have a null result. In other words, for this experiment, 47% is not significantly smaller than 60%. So the BBC would appear to have got it right. Hurrah for the BBC!

The NHS website, Behind The Headlines, also discusses this paper. It rightly points out the flaws in the BBC’s and Daily Mail’s reporting. It then goes on to give a few more details about the study. The subjects had received MBCT treatment for the previous six months and were now in either full or partial remission and taking antidepressant medication. There were then randomised to receive a further 8 week course of MBCT or treatment as usual, which meant continuing with anti-depressants. The treatment arm were also offered support to withdraw or lower medication.

So what exactly is this a study of? The rather innocent sounding (though wordy) title of Mindfulness-based cognitive therapy to prevent relapse in recurrent depression, doesn’t really do it justice.

So which one is the control group? Which event do you think might have the biggest impact amongst people with depression? Being told that you were going to get another course of MBCT? Or being told that you weren’t going to get one? Participants would have to be willing to participate in another course of MBCT before they could be enrolled in the study.

In the field of mental health, the placebo effect is very pronounced. It is typically damned hard for pharmaceutical companies to demonstrate that their latest mood enhancing wonder drug works any better than the placebo. Tell someone that they are going to receive “therapy” to make them better, and lo and behold they start to get better.

Read the literature and you will find that CBT is described as a useful addition to normal drug treatments. So bearing in mind that the placebo effect is very pronounced, what are all these treatments tested against in the control group? Sham therapy? Self help groups? Going to the pub with some friends?

Nope.

They are all compared to treatment as usual, which usually means treatment with anti-depressants. So the effect could simply be down to the “therapeutic relationship” and nothing to do with the actual therapy. It’s not the therapy that’s making you better, it’s the hour a week you have with your “specialist” telling you that his therapy will make you better, that is making you better.

Patients getting CBT do better than patients who don’t get CBT, but is it the CBT itself, or the therapeutic relationship that is making them better? It's impossible to tell, until someone devises a placebo based control group. I haven’t found one, but then I don’t have the resources to run systematic searches and analyse the results. If you have a spare afternoon, I guess you could have a some fun searching PubMed.

Now back to that Daily Mail headline…

Meditation 'as effective as medication' in treating depression

Really? Is meditation as effective as medication? Well, probably not according to the Cochrane Library. They did conclude that meditation was better than no or minimal treatment on self-related depressive symptoms, but not as good as psychological treatments. So it would appear that patients believe that psychological treatments work better than meditation, which works better than nothing. However doctors weren’t quite so sure - the doctors only noticed a non-significant trend that meditation was better than nothing, and they couldn’t tell the difference between psychological treatments and meditation.

Newspapers and the media like to sell us simple stories. If they resonate with a strongly held social belief, then all the better. Usually the real picture is more complicated, and whether we like it or not the “experts” often do not know the answers. What is lost sometimes in the story is the fact that science is not neutral or unemotional or unbiased. It is after all perpetrated by humans. So let’s just ask a couple questions…

Why would the researchers of the paper behind the headlines, neglect to mention whether the result was significant or not in the abstract?

I wonder if they would have mentioned p if the result had been significant? It’s normal practice to state whether the result was significant or not. Try finding a paper without p being mentioned. I do find the paper confusing, because I can’t work out what hypothesis they are testing. Maybe they don’t mention p because the study appears to be designed to produce a null result anyway.

Why is CBT always tested against Treatment as Usual (TAU)? Sure it may be hard to devise and agree on what would constitute a proper placebo, but how else are you going to know whether CBT is not simply itself a placebo? I guess though you’d have to be brave to design a study knowing it could end up disproving years of training and research.

Of course, that's no reason not to do it.------------Redlan----------------------------------------------------------------

Thursday, December 4, 2008

OK,OK, it's a loaded question, it may not surprise you to know it's the latter. To be honest, I'm bored of homeopathy. Bored. Bored. Bored.

I'm bored of its nonsensical, illogical, deceitful, uncritical, confused, law-breaking, twisted, underhand, conspiratorial, paranoid True Believers™ who are able to preach their religion in the media, often without any critical appraisal by the cut-and-paste journalistas.

Nonetheless, to labour the point heavily, one of the mantras trundled out time and time and time again is that homeopathy is a holistic medicine. (It is, in reality, neither of those things, but I digress). It treats the person, not the symptoms; it (depending on who you talk to) readdresses the imbalances in the energy fields allowing the body's natural defences to get to work and recreate health. It is impossible to test by the scientific method because it doesn't work the same way as conventional (euggh) medicine.

All of the above are trotted out regularly by True Believers™ of homeopathy and yet a little observation produces a wealth of information that states otherwise.

Tickets: £20 includes a complimentary bottle of the homeopathic remedy Arnica.

OK. Now go through the old 'treat the person not the disease' mantra again and explain how giving everyone a bottle of indistinguishable sugar pills labelled arnica will do that?

Where is the 'taking patient medical history', looking at emotional problems and lifestyle and all the other smoke-and-mirrors rhetoric used to pretend that there is any substance to this quackery? Nowhere. Just give 'em arnica and they'll be fine. (Or more correctly, just give 'em some sugar pills, doesn't matter what the label says, it won't do anything other than a placebo effect).

In a similar vein, sharp-shooting investigative journalist (read: uncritical cut-and-paster) James Connell has offered another fine example of Dr* T's First Theory in the Worcester News:

Thursday, November 27, 2008

I've written about unregulated arthritis product Artrosilium on a number of occasions. The Advertising Standards Agency has just upheld the third complaint this year against Intramed Ltd, the company that markets Artrosilium in the UK.

The first in May 2008 was for selling herbal pills that purported to sort out prostate problems and raise your sexual game; the second in Sept 2008 was promoting more herbal pills (more specifically gingko biloba) which claimed:

By taking just two capsules of Ginkgo Biloba each day you will cope better with stress; your blood pressure will return to normal, a little more each day; your cholesterol level will fall, your short term memory will improve; after just a few days, you'll feel as though you've fallen into a real fountain of youth

The third, that came out this week, was for Vitasvelt, another herbal pill that:

is currently the only slimming product that can give you these amazing results thanks to the powerful action of Negative Calories, Lose 22lbs easily! 100% natural! Each capsule is packed with all the goodness found in 7 1/2 lbs of fresh cut vegetables! VitaSvelt - Lose weight fast eating your favourite foods

All three are unsubstantiated drivel.

Three wrist slaps in one year and there is nothing anybody can do about it. Intramed Ltd are free to continue selling their outlandish snake oil and I have no doubt it'll only be a matter of time before they do it again.

Wednesday, November 26, 2008

The Royal Society of Chemistry has taken this one step further and recently announced that they'll give £1,000,000 to anyone who can furnish them with 100% chemical-free material.

Part of the riot has been caused by Miracle-Gro who have longed claimed (to the derision of anyone with basic chemistry understanding) that some of their products are:

Made from 100% naturally occurring materials. 100% chemical free.

The Advertising Standards Authority have been unusually backward on this and according to a Guardian report by Frank Swain at the time, they stated:

When there is a colloquial understanding of a word, we can take this into account when reaching our decision. In this case, we believe that most viewers are likely to understand the term 'organic' as meaning no man-made chemicals have been used to manufacture, or are present in this product.

I wonder if the Royal Society of Chemistry will amend the remit of its Organic Division accordingly.

I spoke briefly to Jon Edwards at the RSC to see if anyone had taken him up on the offer, apparently a few smart arses had offered him a vacuum or lightning or similar.

So will the companies claiming 100% chemical free status come forward? I doubt it. I'd like to see the RSC approach them directly (and the ASA for that matter) and see where that takes them. A brief google search gives two major arenas - coffee and cosmetics. Coffee, because of the Swiss-water method of decaffeinating coffee (fancy some Colombian Supremo?) and cosmetics, because nasty, evil, vindictive, malevolent chemicals are not good advertising when you're trying to persuade someone to plaster their face in order to hide their natural ugliness. So we have products like The Lip Pencil, 100% organic and chemical free. Oh, luckily it lists the ingredients:

When I'm not laid low I like to go scuba diving and instructing around the UK coast and have one occasion been involved in an RNLI operation. They are an amazing service and save myriad lives per year through sheer bravery by volunteers. The Charity Commission webpage on the RNLI shows them to have 42400 volunteers compared with 1332 staff. I feel it is my duty to donate to them on a regular basis, given that I may need their assistance one time in the future.

Weaverfish are a small spiny-backed fish that annoyingly like to hang around just under the sand in shallow water with their fins sticking up. Weaverfish snacks and small children end up getting stung which can bring up to 30 mins of pain, which is remedied against by placing the sting site in hot water.

Now, the Cornwall College Camborne are investigating as to whether a 200c preparation (remember that's diluted 1:1,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000 or 1:10^400) of bee sting given in tablet form would have any effect. The homeopathic treatments were provided by Helios Homeopathy (Avid readers will no doubt remember that Helios were quite happy to sell homeopathic remedies and prophylactics for Malaria - potentially fatal, of course - without a shred of evidence to show efficacy, because none exists. The MHRA have since forced them to remove the offending products from their shelves).

The website links to any results for 2006 and 2007 give you a 'bad link' result, so I tried phoning a few people. Firstly, RNLI (BeachGuards) PR HQ - they had never heard of the study, secondly the chap who was running the 'trial', David Retford, was not for answering his phone. His webpage in the College Cornwall website does have some results though, from 2007.

We find out that n=24 for 2007 with 59 in 2006, so at any rate the result is not worth a whole lot. His results state:

the time to it took for participants to leave was less in group A: an average of 18.19 minutes (homeopathic group), as opposed to 19.71 minutes in group B (placebo group).

He claims that the 'rate of pain relief' is significant at p=0.051. I claim that with n=24 the whole thing is pointless and one and a half minutes is neither here nor there.

The article describes local homeopath Janine Whitfield MLCHom, MARH from New Path Homeopathy and her quest for the perfect childbirth.

Uncritical, sycophantic, factless, un-researched and vacuous, the feature takes us through Janine's plan for (I assume) her first childbirth experience. Now, we have been reproducing pretty successfully in one form or another since the primordial soup, and it's fair to say that we are getting better at it.

This graph is taken from Inequalities in infant mortality: trends by social class, registration, status, mother’s age and birthweight, England and Wales, 1976–2000, the .pdf of which can be found here. (I tried to find a suitable one on Perinatal mortality but time didn't permit). I was surprised to see even such a dramatic change in the 25 years or so the graph covers - so despite Janine's insistance on using quackery to safeguard her from the spills of modern childbirth, her chances are pretty good already, which is lucky given that she is giving everything over to sugar pills; even her independent midwife who will be present at her homebirth, is a homeopath.

Janine "understand[s] the way they work" which puts her ahead of every other person in the world (including other homeopaths) who can't agree on why they think it works, despite being continually demonstrated to be no better than placebo.

Then we get into the sticky ground - the ailments. Janine believes that the following, experienced during childbirth, can be relieved by homeopathic remedies:

nausea, low energy, swollen legs and high blood pressure

Well, the sugar in the pill might help with the low energy, but apart from that it's all looking pretty dodgy. Indeed her website goes further claiming

[Homeopathy] has also been used effectively with people suffering from severe illnesses such as cancer or HIV and AIDS, where it can help to treat the often distressing associated symptoms, and provides much-needed mental and emotional support for patients and their families.

But homeopathy doesn't treat symptoms, it treats the person, I thought? Up is down, black is white, square is round, same old nonsense.

Next we get to (admittedly, a new one on me) Biochemic Cell Salts. These are from the same stable of quackery as Hahnemann's homeopathy, but not quite as dilute:

The tissue salts are prepared in dilute form, are non toxic and safe to use during pregnancy.The month by month programme can help circulation, reduce the chances of heartburn, help prevent swollen ankles and help prevent stretch marks.They also have post natal benefits, helping with speeding up the recovery, healing, problems during breastfeeding and post-natal depression.

Woah! Post natal depression? Stretch marks? The journalist shows no incredulity and accepts this nonsense as perfectly reasonable. No questions, just resigned acceptance - any nonsense this woman said will be unreservedly copied and pasted to the readership. Post-natal depression - sure just take this useless pill and get on with life! This isn't a self-limiting minor problem, someone in this state needs care, support, help - not quackery.

There is an argument going on in meeja circles about the future of regional media outlets. The BBC is expanding its local online news services much to the chagrin of the local newspapers' owners. One would hope that whatever happens, local newspapers would be forced to raise their game a touch - printing uncritical nonsense like this does no-one any favours (except, perhaps giving the homeopath a few extra clients), does nothing for the public understanding of science and (at least in this case) some competition from a (usually) more thorough news outlet would serve the local population an awful lot better.

Earlier in the week, I blogged about the Tragic Case of Russell Jenkins, a man whose belief in alternative medicine and shunning of modern medicine appears to have led to his death. I hope in the extremely unlikely event of a problem during the birth, both Janine and her homeopath midwife have the sense to revert to real medicine and forget the quackery.

Wednesday, November 19, 2008

The Natural History Museum is one of the most amazing attractions in London. That's not opinion, its evidence-based fact. The science made available to the public in the NHM is outstanding and world-class - I haven't seen the new Darwin Exhibition but if past exhibitions are anything to go by, it will be top notch historical science.

Why, then, is the NHM dedicating valuable research time and effort to create a homeopathic database of the various plants, fungi, lichens and algae used by quacks to make useless sugar pills?

From the website:

The homeopathy database is a standard reference system for homeopathic practitioners, and other users of plant remedies. It reconciles the old homeopathic codes with the current botanical code. The information is based on long established remedies in the Homeopathic Materiae Medicae that are now revised and updated and the online access means it can be maintained and updated easily in line with current concepts of botanical nomenclature.

For such a reputable and outstanding source of science education to be involved with quackery at this level is to denigrate the good name of the NHM and to give homeopathy a scientific acceptability that it does not deserve.

Indeed, are they include other things that homeopaths have made provings of? I would be interested to see if they will have the proving of the shipwreck, which was inferred to somehow provide prophylaxis against traffic jams. Such is the bonkers world of the homeopath.

Finance for the project came in part from Ainsworths, Waleda & Helios, all UK purveyors of homeopathic quackery. (Avid readers will no doubt remember that Helios were quite happy to sell homeopathic remedies and prophylactics for Malaria - potentially fatal, of course - without a shred of evidence to show efficacy, because none exists. The MHRA have since forced them to remove the offending products from their shelves).

The NHM is doing itself and science a huge disfavour by giving research effort and webspace to quackery. I can see how the databases of flora used in medicine can be worthwhile from a historical and taxonomical point of view, however there is no need to give any credence to homeopathic magical sugar pill-ery along the way.

The value of a visit to NHM in terms of science understanding is well appreciated. Sally Collins and Andy Lee co-wrote a consultative study into how Natural History Museums can support secondary science teaching and learning (.pdf here). A brief quote from the Foreward by Sir Mike Tomlinson:

The importance of science in our lives has never been more obvious, yet we continue to grapple with the challenge of enthusing students with science at school and its study post-16.

Teachers readily acknowledge the need to ‘bring science alive’ and to enable students to understand how science and scientists work. Teachers cannot do this on their own, which is where natural history museums can be so important.

This report clearly reveals the positive and lasting benefits of visits to natural history museums and engagement with scientists working there.

Why put this in jeopardy by introducing students to blind quackery while trying to teach them about science?

Tuesday, November 18, 2008

From time to time, I get asked why I bother putting the screw on various complementary therapies - my usual first response is as someone who finds science interesting, overwhelming, incredible and at times barely believable (but always based on rigorous experiment), I get frustrated at people inventing non-sensical waffle that is often demonstrably wrong, and passing it off as science (usually to make money).

Further on in the conversation, the phrase "well, it's fine as long as you don't take it too seriously" rears its fence-sitting little head. If that's the case, why no just ditch it now and be done?

Also from time to time, something happens that demonstrates clearly, tragically and painfully that you ignore conventional medicine at your peril and there are occasions where no placebo, no therapy, no energy, no matter how theatric will affect your situation. These have been collated at What's The Harm? and the story that follows will no doubt be added to that list in the near future. The Lay Scientist has written up the story here.

The inquest of Russell Jenkins took place this week, following his death in April 2007. The Coroner recorded a Narrative Verdict, meaning the cause of death is not attributable to anyone.

Mr Jenkins was a spiritual chanting artist who set up the Quiet Mind Centre at his home in Southsea in 1992, offering Reiki Massage, reflexology and the like.

After standing on an electrical plug, Mr Jenkins ended up getting an infection in his foot, which given his condition as a diabetic, was quite serious. Unfortunately, his 'inner being' told him not to go to hospital and his partner, Cherie Cameron who lived with him and joined the Quiet Mind Centre in 2002 also did not seek medical help. Ms Cameron still works at the Quiet Mind Centre, and despite previously being a theatre nurse did not see the danger in what was happening.

Mr Jenkins called on the advice of a homeopath, Susan Finn. (There is no mention of a Susan Finn in the records of either the Society of Homeopaths or the Alliance of Registered Homeopaths). By this time the foot had become gangrenous and it appears Ms Finn did not offer a homeopathic solution, instead suggesting he cover it in manuka honey.

This for me is the gut-wrenching part of the story. Susan Finn, regardless of her training or background, had a terrible situation on her hands. Here was a patient who was quite clear that he did not want to go to a Doctor or hospital and wanted alternative treatment, yet I'm sure she must have pleaded with him to get medical attention, despite her alternative beliefs.

His condition deteriorated and on April 13 he was forced to take to his bed. When Ms Finn visited the following day, she saw blood on the bed sheets and described a foul smell in Mr Jenkins's bedroom. His foot was swollen and one of his toes was discoloured. Two days later Mr Jenkins's condition had rapidly worsened and his toes had turned black.

Even at this stage, Mr Jenkins refused to seek medical help with the tragic consequences that about a day later, he died from a 'mixed bacterial infection'. Mark Pemberton, consultant vascular surgeon reckoned that even 2 hours before he died, he had a 30% chance of survival.

This is quite a disturbing story and in fairness, I'm not sure how I feel about it. Where does the point of allowing someone the choice to make their own decisions stop and the point of overriding their belief system for their overall good start? I guess parallels can be drawn with religious beliefs where a medical practice viewed as 'illegal' within the community will result in an unnecessary death - blood transfusions for Jehovah Witnesses are one such example.

One thing is clear, anything that can be done to solve the problem and counteract the pseudoscientific claims of well-meaning but misguided believers long before it gets to this stage has to be a Good Thing.

Monday, November 17, 2008

"The outcome I would be really happy with is a better understanding of healthy eating", said teacher Paul Whitaker, from Auckland's Wellsford School, according to TV.NZ.

What I assume he meant is "The outcome I would be really happy with is a better understanding of the scientific method, placebos and possibly the Hawthorne Effect".

It appears that after watching a BBC documentary on Omega 3 fish oils, Mr Whitaker decided to run a trial of his own: 42 pupils, 21 with a fish oil pill and 21 without, otherwise, everything was the same. The story was also picked up (slightly, but only slightly more sensibly) in The New Zealand Herald.

Now, Mr Whitaker makes a big enough song and dance about his results to allow me to pilliory him as a bit of a fool. It would be unkind to say that not much happens in NZ, and indeed this is no excuse. History repeated itself in many ways with the ghost of the nonsensical Durham Fish Oil trial/experiment/initiative/trial (still being admirably hounded by MacCruiskeen) being resurrected - the pills were given free to the school by Good Health, a NZ-based 'natural health solutions' company, who are happy to tout the trial as a success (despite not being finished yet) and give a list of some of the media exposure gained. (Save lazy people like me having to do too much Google trawling).

In a very similar case to Durham, the trial was poorly designed scientifically and a waste of time, although excellently designed from a point of view of getting a false positive with which to spin to the media.

First of all, 42 people is never enough to get any meaningful results - at best it may give an inkling as to the next direction your research will take.

Secondly, the person running the experiment knows everything about who is getting what and how well they are expected to do etc etc. This is where blinding normally comes into it. The amount of personal bias put into this trial (both unwittingly and perhaps wittingly) makes any results valueless. Did Mr Whitaker bias the choice of pupils in each category so that the trial would be a success? Who knows and indeed who cares, because there is so much more wrong with this trial.

Thirdly, what about a placebo? No placebo makes the trial an investigation into the Hawthorne effect - people perform differently when they know they are under test. You remove the problem by using a placebo.

Fourthly, the results are interpreted by Mr Whitaker - again the bias is open to his perception.

He said the 21 students taking the capsules for two months [...] were now six months to one year above where they were before they began taking Omega 3.

Really? They had moved a year ahead in 2 months? Read over that again - they had moved ahead by 1 YEAR in 2 MONTHS. That is a result. That is a HUGE result. Imagine the money that could be saved by shovelling fish oil down all these kids necks! IMAGINE! It's clear that this is just not the case.

Fifthly, why is the trial being touted as a success when it still has months to run?

Whitaker's experiment is expected to continue until the end of the academic year in December.

Why is this being treated as a media press release and not a scientific paper? The answers are pretty obvious, of course.

Now, you may think that this posting is an obsessive rant regarding a fairly small study in New Zealand, a bit of publicity and PR spin and not much more than a bit of fun. Well, I object to the following:

1. Children being tested on (especially when there is no possible knowledge gain, and only for a pill company to sell more pills)2. The public's understanding of science to be further cheapened.3. The media again showing no basic scientific criticism because they are scientifically illiterate and unable to carry out journalism as opposed to press release restructuring.4. Lying to children by telling them the reason they have got good results is nothing to do with their hard work, but due to a pill and that's the way society works, so take your foot off the gas, kick back and get on the vitamins.5. Lying to children by telling them the reason they are not progressing is because they aren't taking pills and not because they are not as smart as other kids or have some learning difficulties.6. The medicalisation of "intelligence" as something which can be found in a bottle of pills.7. Pill companies benefiting from all the above, and using the nonsense to pretend their brand of placebo is 'scientifically proven'.

No doubt this will prompt someone to do a formal trial of the fish oil pills. I wonder how meticulous they'll be? One can only assume that (especially with Durham) there is no interest in actually finding out whether or not there is an effect. A negative result would have too much of an impact on the bottom line.

Although the Department of Health provides strategic leadership to the NHS and social care organisations in England, it is for local NHS organisations to plan, develop and improve services for local people. These bodies are best placed to respond to patients’ concerns and needs, so it is their responsibility to commission healthcare services and treatments. The clinical and cost effectiveness, safety and availability of suitably qualified practitioners are all issues that have to be taken into account when deciding what treatment to provide.

The White Paper Our Health, our care, our say makes it clear that Primary Care Trusts (PCTs) will be holding GP practices accountable for the use of public money under practice-based commissioning, and that PCTs will be expected to support practices that are innovative and entrepreneurial, and which extend patient choice.

Now there are a few little tidbits to translate out of the bureaucratese and into english:

1. It is for Local NHS organisations to decide on clinical and cost effectiveness.

Fair enough. This phrase has to encompass non-efficacious quackery and efficacious-but-prohibitively-expensive treatments.

2. GPs are accountable to Primary Care Trusts for public money spending.

Again, no real drama.

3. "PCTs will be expected to support practices that are innovative and entrepreneurial, and which extend patient choice."

Hmmmm. I can't really get my head round this one. I would have liked to have seen a clause involving 'evidence-based' or 'science-based' in this statement. It's easy to increase patient choice and be entrepreneurial, but only if you are prepared to disregard the laws of biology and physics, lie to your patients and fleece them for placeboes.

Still, I'll take this in a positive manner, and hope that the statement is intended to promote new, evidence-based therapies and techniques which for whatever reason are not part of the historical GP surgery. Perhaps some increased dietician involvement to avoid future problems with obesity, diabetes etc.

What it doesn't say, however, is anything about homeopathy, which for a petition about homeopathy is rather strange. I would suggest that the government petition replies should adhere to following rule:

"A reasonable person should be able to guess the question, having got the answer".

Thursday, November 13, 2008

For those of you in the UK, the BBC iPlayer has the program here, it runs from about 1min 7secs to 11 mins 38 secs. (Unless some kind bod pops it onto YouTube, I'm afraid non-Brits will have access issues).

The main villain in the piece is Barbara Wren, who runs the College of Natural Nutrition. A quick hunt on Google shows that she is anti-vaccines:

Barbara Wren, Principal of The College of Natural Nutrition, regards the customary procedure of vaccination as having a considerable damaging effect on the health of the growing and adult individual. Throughout her twenty five years of practicing, Barbara was able to observe the unequivocable results that vaccinations have on long-term disease patterns, affecting the physical, mental and emotional being.

and the College of Natural Nutrition happily plays along with the 'WiFi causes cancer' hoax that pops up every so often. Luckily, Nicola Summers at The College of Natural Nutrition is on-hand to explain how:

In natural nutrition terms, the pulsing electromagnetic signal enters the body, disrupts the electron cloud that surrounds our cells, which impacts the way the cell behaves, alters the charge of the cell and ultimately influences how the cell reproduces. This will of course have an extremely stressful impact on the body leading to dehydration, mineral misplacement, congestion, lack of ability to break nutrients down fully and so on.

If I meet her, I must ask her more about the electron cloud that surrounds her cells - one can only assume that the phrase "In natural nutrition terms" means the same as "in made-up lala land". She also kindly provides a link to EmFields, which is the new incarnation of Alasdair Phillips of PowerWatch.

So, all in all, The College of Natural Nutrition is shaping up to be proper little microcosm of nonsense. Like so many areas of woo, water seems to be key. Keeping rehydrated will of course keep most diseases as bay, but not any old water.... oh no, you need special, fetishist water - allow Barbara to explain:

Some Helpful Hints on Drinking Water:

Nothing, no substitute liquid, replaces pure water.

I usually recommend using bottled water, in glass if possible. Look for 'empty water' i.e. for a low content of minerals, especially sodium (Na) and calcium (Ca). Of the bottled waters, Volvic is one of the best, as it has the lowest surface tension and is one of the "emptiest"; unfortunately it has the disadvantage of being in plastic bottles.

If you can distill [sic] water, and thus "empty" it, that is ideal. Reverse osmosis with the addition of an activated filter is quite a good alternative. In many areas it is possible to have distilled water delivered, quite inexpensively. The best solution is in fact to have a still, which I consider to be a good investment, and to distill into glass. Any other sources are a compromise to a degree, and we have to select what we can from among the options. I use a little still which does a gallon every 8 hours and there is no message in distilled water. If you use distilled water, you need to pour it from a height of about 15 ins, in order to oxygenate it (and "enliven" it). Also you may wish to use a crystal, for example placed in a water jug, to energize water.

My bold, purely through lack of comprehension what it means.

Crystal therapy box ticked. Not a surprise if you take a look at the company she keeps on MySpiritRadio.

One of the students of Wren's is Barbara Nash, whose insurance company paid out £800,000 without accepting liability for giving advice to a patient (interviewed in the InsideOut program) which when allegedly followed left the patient brain damaged. Ben Goldacre, who was also interviewed for the program, wrote about the Nash case in his Guardian column at the time.

Anyway, you can imagine that BBC Inside Out SouthWest didn't have to delve to far into the lectures of Barbara Wren before the alarm bells rang.

Firstly, Barbara Wren's claim to cure thyroid cancer by using a dressing of castor oil and urine was met with understandable incredulity by Catherine Collins from the British Dietetic Association. Obviously, given Barbara's distrust of WiFi, it shouldn't come as a surprise that she reckoned the cancer was caused by a computer under the person's bed - a 'huge electromagnetic disturbance'.

Secondly, Barbara Wren suggests (insists?) on her students taking 25 times the maximum recommended dose of Iodine in supplement form, which is only available from the petshop as a water treatment chemical for fishies.

The presenter makes a valiant effort to take Wren to task over these suggestions, but to no avail.

This leads her to finish up with the line "Be aware of who you believe and what advice you swallow", but that isn't easy when most of the Main Stream Media is uncritically pumping this kind of rubbish out, giving people like Barbara Wren a platform from which to spout this type of nutritionist bullshit.

Wednesday, November 12, 2008

Paul Dacre, Editor of The Daily Mail, addressed the Society of Editors in Bristol this week, and his speech was printed in Monday's MediaGuardian. Throughout the week, various commentators have responded to Dacre's uncharacteristically public outburst, including Max Mosely and Polly Toynbee.

His main gripe was that the "British press is having a privacy law imposed on it" by one man, Justice David Eady who has used the privacy clause of the Human Rights Act to stop various sordid details of famous private lives making it into the public domain. Dacre uses the case of Max Mosely who famously sued News of the World for printing details of his S&M fun and games.

So what is the impact on journalism of this impinging privacy? According to Dacre:

[It] is undermining the ability of mass-circulation newspapers to sell newspapers in an ever more increasing market.

I hardly need write any more about what a nonsensical argument this is.

Dacre refers to the Human Rights Act as 'wretched' and maintains that Mosely was guilty of 'unimaginable depravity', which given that it appeared to be people engaging in consensual sexual practices, makes me wonder what hyperbole he would use to describe the recent stories of, say, alleged genocide in DR Congo, or the tragic death of Baby P.

These are only limited examples that I've come across - I tend to agree with Polly Toynbee in that Dacre

probably does more damage to the nation's happiness and wellbeing than any other single person, stirring up hatred, anger, fear, paranoia and cynicism with his daily images of a nation going to hell in a downward spiral of crime and depravity.

So will the newspapers circulation keep falling if we can't find out about the legitimate sex lives of various glitterati? Perhaps Dacre would do well to start looking for some real stories. Stories that are bubbling in the background; stories that bloggers write about, unable to believe that bigger media outlets aren't already all over the story. Already this week we've had, amongst others:

These are huge stories that will no doubt remain untouched in the media, yet they are important stories that newspapers should be hounding down and publicising. These blogs are only in the pseudoscience genre, no doubt similar blogs exist in the arenas of economics and politics etc.

The real investigative journalism is being done for free by unpaid bloggers with no vested interests but a good story. If Mr Dacre wants to increase newspaper sales, he should do some real investigative journalism rather than whining like spoilt child.

Even BBC Breakfast is having a go, promising that 'rarely have we seen such clear and dramatic results'.

But before we all rush to the doctor demanding prescriptions of Crestor to crush up and put in our morning cereal, I thought I'd take a slightly closer look.

So, this story is about the The JUPITER Study which was published online in the New England Journal of Medicine on 9th Nov 2008. The study looks at patients with relatively low levels of total (HDL+LDL) and 'bad' (LDL-C) cholesterol but with elevated C-reactive protein (a marker of inflammation), and looks at the effect on several cardiovascular events (notably Heart Attack and Stroke) when treated with rosuvastatin 20mg or placebo.

Now let's start with the good stuff - this trial does tick the Thinking Is Dangerous box of acceptable trial design. The trial is Double-blind, Randomised, Placebo controlled, Multi-Centre and Peer review published. Disclosure of the randomisation is pretty good and thorough with very low differences in risk factors across the groups.

The headline grabbing stuff tells me that if I take rosuvastatin I can slash my risk of heart attack by 58% and stroke by 48% even if I have normal levels of cholesterol. Well what could be wrong with that? Surely, a miracle has occurred here today?

Well, no. Not really.

There were 31 Myocardial Infarctions (Heart Attacks) in the treatment group compared with 68 in the placebo group. Each group had 8901 patients in it. There were 33 strokes in the treatment group and 64 in the placebo group.

In real, proper, everyday terms, this means that if I have normal cholesterol levels, but higher c-reactive protein levels, over 2 years:-

- My risk of heart attack goes from a rather disappointingly low 0.76% to an indistinguishably lower 0.35%.

- My risk of stroke goes from a most decidedly non-headline-grabbing 0.72% to a yippee-I'm-gonna-live-forever 0.37%.

Putting this into context, it was the Scandinavian Simvastatin Survival Study (4S) in the 1990's which really propelled the statins into the biggest selling drug class of all time. This study, also Randomised, Multi-centre, double-blind, placebo controlled and peer review published, enrolled patients with high cholesterol levels, compared Simvastatin to placebo and looked again at cardiovascular outcomes.

In this study, the risk of having one or more major coronary event went from 30% in the placebo arm to 19% in the treatment arm! Now these numbers are impressive.

It is worth noting that the Relative Risk Reduction in both trials is roughly similar, but that the real world Absolute Risk Reduction of JUPITER pales in comparison to 4S. And yet, have a look at the media outlets with their impressive numbers and listen as they demand that NICE start funding high doses of expensive statin in primary prevention to make, well, little difference to most people really.

In the interests of fairness it should be pointed out that these studies looked at different patients with different risk factors. It should also be pointed out that 4S had a follow up of 5.4 years whereas JUPITER was stopped early after median follow up of 1.9.

However, my point still stands - The Media, and let's not forget Astra Zeneca themselves - (bless them) will go for the big numbers and the huge claims and to hell with context - but then 'New Study Reduced Risk of Heart Attack from 0.76% to 0.35% for only some people' won't set the media world on fire.

Monday, November 10, 2008

Two weeks ago today I had an open hip debridement on my right hip. At 31, I was about half the age of most of the other people having similar operations, but I guess that's not too surprising. Cam impingement and subsequent treatment seems to be a reasonably new area of medicine and as such the techniques are still being developed. (Given the nature of this blog, I thought CAM Impingement was quite an ironic pathology for me to have)

Nonetheless, the above will explain the lack of blog activity over the past while, and indeed may explain the (anticipated) blog over-activity in the next few weeks! Sometime in the New Year I will be getting the same debridement on my left hip, so you may suffer the same famine and feast again then.

As it turns out, the consultant is confident that the pain I was experiencing before the operation won't get any worse, but couldn't say whether it would be less, so in reality I'm faced with potentially having the same chronic pain I had before the operation, but with the strong hope that it won't deteriorate.

In a timely manner, Sense about Science has published their latest guide "I've got nothing to lose by trying it" (the document can be downloaded from the top right corner of the SAS page). For this guide, SAS has teamed up with a number of charities including Multiple Schlerosis Society and Alzheimer's Society to provide some education and awareness of how, as consumers, we need to be incredibly alert to quacks offering us hope of symptom relief, usually in return for cash. Needless to say, the quacks generally take the money and leave the pain.

I have written on a number of occasions about Artrosilium, the arthritis gel aimed at the 5 million or so Britons who have arthitis or similar diseases. Despite having been slapped by Advertising Standards Authority in May 2004 and making the MHRA hitlist for unregistered medical products in 2003 and so not allowed to be sold in the UK, the product was still being sold via the website at www.artrosilium.co.uk, until a complaint to the MHRA from this site had the website closed. The website has since reopened at http://www.artrosiliumonline.com/ but at least it does not bear the .co.uk web address, which gave a false feeling of UK regulatory legitimacy.

Searching for this product in Google brings 50% of Thinking is Dangerous' traffic, which shows that more and more people are using the net to try and get hold of fantasy quack medicines that somehow will prove to be the elixir they dreamed of. (I recently wrote a short piece for Sense About Science's Evidence-Based Medicine Matters project, along the same lines, and found myself (slightly embarrassingly) in very esteemed company!)

This is not to say that the purchasers of these products are stupid or uneducated, but more that when faced with chronic pain with no respite, people buy the dream, and don't give much thought to the evidence. The flipside of this is that there is a pretty penny or two to be made preying on these people, and this is where the unscrupulous quacks and marketeers are ready to pounce, pretending to be by your side offering you the solution, when in reality they are preying on your belief and hope of a so far impossible remedy.

The SAS guide is written to help people recognise quack treatments and is mainly concerned with neurological conditions, although it would have been great to see arthritis (rheumatoid & osteo) in there as well, as many of the same issues are experienced by arthrites. The BBC website has a brief video clip of arthritis/ME sufferer Daniella Muallem and her experience of quack remedies, which imparts rather well the importance of evidence-based medicine, as well as how non-conventional medicine can be purely an excercise in wallet-lightening.

So, as I sit here and recouperate, I'll mull over the fact that there is less cam impingement in my hip, and hopefully less CAM impingement in patient healthcare in general.BPSDB

Thursday, October 16, 2008

Avid readers of this humble blog should know by now the sort of fodder that boils up a Thinking Is Dangerous blogpost - dodgy quack medicines being touted as wonderdrugs, newspapers taking no notice of integrity and printing anything that pops into their inbox, the rubber-toothed fight by the Advertising Standards Authority to keep things in check, that sort of thing.

Once in a while, a story pops up which presses all the buttons, and with only a whisper of fat-fingered googling, I can sit in amazement watching the pieces of the story happily fall into place like a Christmas morning jigsaw.

Once again we'll turn the TID spotlight to arthritis, the Daily Mail, the ASA, and pretty pennies being made.

Modern medicine, although coming on leaps and bounds, is still a bit duff when it comes to diseases like arthritis. Outwith mechanical intervention, pain management is about all there is, and even then, the painkillers can have side effects and long term effects that aren't much fun.

Put yourself in that position - constant chronic pain, only slightly eased by medication - and suddenly old wives tales, exotic berries and other natural products seem to hold the answer. We can't hope for pill-pushers and nonsense therapy merchants to have much proof, because people buy the dream, not the evidence. We need medicine and knowledge that is evidence-based to be able to base our pain-management approach on treatments that have been shown to be effective. Otherwise, we're throwing our money at the moon.

We start the rosy story off with the Daily Mail, providing another excellent candidate for Dr* T's First Theory as it announces:

Why so many touts for the humble hedgerow habitant, rosa canina? Well, it should take you less than 5 seconds to realise that the connection between all the touts is a product called LitoZin.

Here are a few quotes from the Daily Mail report:

A herbal medicine made from rosehips may regenerate joints in people crippled by arthritis, say scientists.Studies show it can protect the cartilage cells which facilitate joint movement. Researchers claim the red hips - one of nature's richest sources of vitamin C - also improve activity levels by damping down an over-active immune system.

The Swiss studies looked at the action of the sugary fatty acid GOPO, the active ingredient in the rosehip supplement LitoZin. Researchers from the department of human nutrition and health in Basle, Switzerland, measured the effects of different doses on human cartilage cells.

The Department of Human Nutrition & Health in Basel, eh? Which university is that associated with, or indeed, why doesn't it say the name of the organisation? That's probably because the scientists are part of the Department of Human Nutrition & Health at DSM Nutritional Products, Basel, who manufacture i-Flex (nothing to do with Apple) which is marketed in Europe as .... LitoZin. (Press release here)

What a surprise. Now why was that bit left out of the Daily Mail report? The trademark is actually held by Dansk Droge, a Danish company, and perhaps why a lot of the Daily Mail articles refer to scientists in Copenhagen.

Now let me make two important points - firstly, the research may be of an astounding quality and impeccable beyond reproach. However, the fact that Daily Mail hides this information makes me think maybe it isn't. Also the fact that it is "announced at the Osteoarthritis Research Society's International World Congress in Rome" rather than in a peer-reviewed research journal means it's difficult to find out what went on. Secondly, there may well be some active ingredient in rosehips worth looking at, but, as I said above, with products like these, good research does little to enhance the sales, because people are buying a dream, regardless of the evidence. (I'll also remind you that we arthrites seem to be particularly susceptible to placebo). Why bother putting together a large well-run trial, when the same sales can be achieved by 2 or 3 small irrelevant ones?

So to recap, Daily Mail has published, on 5 separate occasions PR fluff from DSM (or their UK distributors - LanesHealth www.litozin.co.uk, or online from www.arthritis-relief.co.uk) citing little/no firm evidence but being suspiciously cagey about where the evidence came from. Such is the state of churnalism in the UK press - the stories we read are there because they help line the pockets of the pill peddlers (and their PR agents) and nothing to do with public service, furtherance of scientific advances or importantly, helping people suffering from arthritis, except to empty their wallets.

One organisation who decided the evidence is absent, is the bastion of company's claims in print and other media, the Advertising Standards Authority. I've written about the ASA on a number of occasions, and praise them from the rooftops. My angst with them is that they have no power and no bite, save producing indirectly a few bits of negative PR.

Healthy Marketing Ltd (trading as Woods Supplements) came up against the ASA this week (15th Oct 2008). A direct mail catalogue had a claim, headlined "Rose-Hips may Ease Arthritic Pain ... ", appearing next to an image of the Daily Mail article headlined "Are rose-hips the answer to the agony of arthritis?", which stated rose hips had an unknown active ingredient that affected the blood cells involved in inflammatory and immune responses. The catalogue contained a myriad of en vogue health supplements which you can enjoy at your leisure.

According to the adjudication, Woods Supplements provided information, abstracts or the references of studies related to the properties of each supplement, including the Rosehip pills, to which the ASA summed up as follows:

We noted some references to clinical trials but that there was not enough information for us to assess whether the trial was valid or supported the claims. We therefore considered the information provided was insufficient to substantiate the claims made about the benefits of the supplements. We concluded the claims had not been substantiated and were therefore misleading.

So there you have it. Unsubstantiated and misleading. In the interests of disclosure, I should mention that I eat rosehip syrup quite often. Not for arthritis, but because rosehip syrup is easy to make, cheap and fantastically tasty with greek yoghurt. Maybe one day the pill peddlers will carry out a well-run clinical trial on rosehips which will warrant me to really indulge.

Saturday, October 11, 2008

At the risk of invoking a variant of Dr*T's First Theory, I'd honestly like your opinion on the following:

This week, I blogged about the GAIT trial, or Glucosamine/Chondroitin Arthritis Intervention Trial, which was a large randomized, placebo-controlled trial conducted at several sites across the USA comparing glucosamine & chondroitin with placebo and paracetomol for arthritis.

We've got the trial out of the way and we know that the results, although interesting, really confirm what we already knew about glucosamine, in that it's not a magic pill. It's just a pill. A pill that us highly suggestive arthrites rely on, perhaps, for pain relief as placebo, but with no actual effect.

Now comes the odd part.

If you type "gait trial" in Google in UK, the first hit is www.GAITtrial.co.uk. If you go to www.GAITtrial.co.uk you are presented with a very professional website, made to look like it has some affiliation with the GAIT trial mentioned above. However, there are only two pages and no details about who has written it or who they are representing, but it helpfully gives us a few links at the bottom to where we can purchase some glucosamine.

Firstly, the pages information is considerably more positive than the trial researchers indicated - in fact, it says the direct opposite; compare

Secondly, the links at the bottom of the page are suspect - the first two, for Boots and Health Perception don't work, but the third for Joint Care does and it takes you to the Seven Seas Joint Care "Everyone needs healthy joints" website, advertising all manner of glucosamine pills.

Is it a coincidence that only the Seven Seas link works? Well, possibly, but another website, also designed by Two's Company Design Studio Ltd, which discussed the GUIDE study , a small European study that gave weakly positive results for glucosamine, the same thing happens. As an observation, whoever "sabotaged" the links did so in two different ways on the two sites, implying that only one link is supposed to work - the Seven Seas one.

Is this Seven Seas gently directing people to its site using false, hyped-up information, but without explicitly having to make the claims themselves?

...there is very little medical evidence to back up the effectiveness of supplements, such as chondroitin and glucosamine. Although there is little medical evidence to back up the effectiveness of glucosamine hydrochloride, recent research has shown that taking glucosamine sulphate (which is found in healthy cartilage), or fish oils, may have positive results. However, the NHS cannot recommend, or prescribe, the use of glucosamine sulphate because it does not often prove to [be] cost-effective.

Hardly a resounding endorsement. So what is that "recent research"? Well, unfortunately, the NHS page doesn't give the reference, but I'll bet that it is probably the GAIT trial - The Glucosamine/Chondroitin Arthritis Intervention Trial, which was a large randomized, placebo-controlled trial conducted at several sites across the USA. The National Centre for Complementary & Alternative medicine (NCCAM, who were involved in the trial) in the US has an excellent Q&A.

The research has been going on for a number of years, and the first stage of the trial was published in 2006 in The New England Journal of Medicine which concluded:

Glucosamine and chondroitin sulfate alone or in combination did not reduce pain effectively in the overall group of patients with osteoarthritis of the knee. Exploratory analyses suggest that the combination of glucosamine and chondroitin sulfate may be effective in the subgroup of patients with moderate-to-severe knee pain

They freely admit that because of the small numbers in this subgroup, they were unable to to demonstrate statistical benefits, and requested further research.

In a funny "who do you believe?"-type story, Dr Trish MacNair was dealing out Doctor's advice on the BBC's Health Pages and in October 2007 (after this study came out, here advice was (in direct opposition to GAIT, the largest and most relevant study on the supplements):

Glucosamine seems to be less useful when a person has more severe pain from arthritis.

(As an aside, I found this line from the GAIT publication fascinating:

...the high rate of response to placebo (60.1 percent) and the relatively mild degree of pain from osteoarthritis among the participants may have limited our ability to detect benefits of the treatments. Elevated rates of response to placebo have been reported in other osteoarthritis trials and may relate, in part, to patients' biases and expectations and to the enrollment of patients with relatively mild symptoms of osteoarthritis.

I'm pretty sure we all know of people who have arthritis who swear by some secret natural pain-reliever such as honey & ginger hot drinks or cider vinegar - this study seems to suggest that we arthrites will respond well to a raft of placebos; anything to numb the pain! If it "works", that's excellent - stick with it. I have my own placebo, and I know it's a placebo, but a double of Highland Park Whisky with one piece of ice (just one, mind) seems to do the trick and it's more fun than cider vinegar).

Anyway, I'm rambling.

The next stage of the trial has now been released - it is due to be published in Arthritis & Rheumatism (paywalled, although Abstract here), and NCCAM's press release is here, and was interpreted by Reuters here. The results were as follows:

The researchers looked at the reduction in joint space width and found it had decreased less than they had expected which made the analysis more complicated. It's fair to say though that the scientific self-criticism that the press release acknowledges is something that we could do with seeing a lot more of in the CAM world this side of the pond.

They had 572 people for the study and it ran for a further 18 months after the first observation, giving a 2 year study span altogether. Director of the co-funder of the study, National Institute of Arthritis and Musculoskeletal & Skin Diseases, very sensibly said:

Research continues to reveal that osteoarthritis, the most common form of arthritis, appears to be the result of an array of factors including age, gender, genetics, obesity, and joint injuries.

or in other words "It's probably a bit more complicated than that", a phrase which should be used much, much more than it is.

At this point in time, none of the UK newspapers have picked up the story (from credit crunch to bone crunch?), although I did find out that Chesney Hawkes had some cartilege removed from his hip and guess what? He now takes glucosamine.

Keep Libel Laws out of Science

About Me

Who I am is largely irrelevant, and indeed so are most of my thoughts.
Nonetheless, it winds me up that I am supposed to swallow half-truths and untruths relating to scientific claims emanating directly from media sources and indirectly from people who haven't a clue what they're talking about.
Look, you've got me started.
(You can email me at thinkingisdangerousblog AT googlemail DOT com.)